Mismanagement and long-running cultural problems inside the Canberra Hospital maternity unit have put the health of patients at serious risk, an official report has warned, as adverse medical outcomes, inadequate supervision and critically low morale remain.
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Extracts of an accreditation report from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, obtained by The Canberra Times, show patient and doctor health has been compromised as staff levels tank, surgical and ultrasound training is limited and unresolved personal conflicts fester.
The maternity unit's training accreditation remains at risk of being revoked early in 2015 if officials cannot address urgent recommendations.
ACT Health officials declined to the release the full report earlier this month and have launched an investigation into what it described as its alleged and unauthorised release. Director-General Peggy Brown on Thursday rejected some suggestions made in the report about poor provision of care.
The extracts show the unit failed to meet standards in two of eight assessment areas including "registrar staffing, safe working hours and leave arrangements" and "core levels of clinical experience-competency and in-house credentialing".
A further three areas were only "partially met", including training and support with after-hours supervision, learning and educational resources. The unit met standards in three areas including supervisor appointments, coordinator appointments and research.
The review, completed in September, found management is unable to resolve training difficulties which date back years. Accreditors found "acute distress of registrars" due to unrealistic workloads, limited training and political and inter-personal difficulties.
"The unit is significantly at risk of both adverse medical outcomes and personal risk to the health and wellbeing of the registrars," the report said. One section contains an apparent error, stating provisional approval for the training program has been granted until April 2014, rather than 2015.
Canberra Hospital currently has a six-month accreditation for training of young doctors in obstetrics and gynaecology, the shortest possible accreditation period awarded by the professional standards body.
The report recommends the chair of the training accreditation committee for the ACT is "immediately involved" in resolving issues raised. It calls for patient numbers to be reduced in the unit to lessen pressure on doctors.
It highlights staff shortages, a lack of engagement by visiting doctors, increasing birth numbers, shortages of senior doctors, limited clinical experience, poor rostering, conflicting management protocols and "widespread disaffection."
Dr Brown said staff and the ACT community needed to allow ACT Health the time and opportunity to resolve the issues.
"[The accreditors] recognise that this will take some time and whilst ACT Health remain willing to provide regular updates, we do require the medical, nursing and midwifery staff to work together with us to implement the required recommendations."
Officials had raised some points ACT Health considered inaccurate and improvements were under way to a range of areas including booking systems, supervision, recruitment and rosters, Dr Brown said.
A working party has been established to progress implementation of the report's recommendations, with one accreditor involved.
"ACT Health remains of the position that it will not be releasing the report publicly as the purpose of any college accreditation process is to continually improve the training program provided and in order for this arrangement to work successfully, both parties need to feel confident that trust and morale exist between both parties," Dr Brown said.
"Responding to public commentary impacts on this trust and impacts negatively on the public perception of the service, which remains of a high standard."
She said officials were very concerned a member of staff appeared to have distributed the report without permission.
Chief Minister Katy Gallagher said she was monitoring the situation.
"Since being made aware, particularly of junior doctors concerns, I am satisfied that the Director-General of ACT Health has taken all steps necessary to address the concerns raised. I am being briefed frequently on progress."
Opposition Leader Jeremy Hanson said the report appeared to be "extremely damaging and damning".
He will move a motion in the Legislative Assembly next week calling for the full release of the accreditation report and for Ms Gallagher to outline her own actions to address the urgent concerns.
"If indeed this is the accreditation report, it doesn't get more serious than this. What it is saying is that mothers and babies are at risk."
